The war on milk has shifted fronts. First it was sugar-laden chocolate milk, which parents and school administrators battled in recent years to remove from school-lunch menus. Now, it's plain old moo that's under fire.
On Thursday, a national doctors group petitioned the U.S. government to remove milk as a required food group from theNational School Lunch Program, the federally assisted program that has provided lunch to millions of public school kids since 1946. The doctors' reasoning: milk doesn't help protect kids' bones.
The promotion of milk to help build strong bones in kids is, "in effect, the promotion of an ineffective placebo," writes the Physicians Committee for Responsible Medicine (PCRM) in itspetition [PDF]. "Milk is high in sugar, high in fat and high in animal protein" — all of which counters its purported benefits to bone health, the committee argues.
The PCRM notes that dairy products, including milk, are the No. 1 source of saturated fat in Americans' diets. Drinking milk for the calcium it contains is therefore a losing strategy, especially since people can get their daily recommended calcium from other, more nutritious foods. And for millions of Americans who are allergic to milk — including 1.3 million children — or intolerant to the lactose it contains, drinking milk carries potentially severe health risks.
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"One of the only reasons people talk about dairy, or promote it at all, is because it is going to help build strong bones," says Dr. Neal Barnard, president of the PCRM. "Research has now made it abundantly clear that milk doesn’t build strong bones. Whether we are talking about children who are forming bones or older people who are trying to keep their bone integrity, milk doesn’t have a beneficial effect on either one."
Is that true? In March, a study published in the Archives of Pediatrics & Adolescent Medicine followed a group of 6,712 girls over seven years, tracking their diets and assessing their likelihood of stress fracture. The researchers found that neither calcium nor dairy intake was associated with a lower risk of such fractures. Similarly, 2003 data from the Nurses’ Health Study, which followed more than 72,000 postmenopausal women for 18 years, found that milk drinkers were no less likely to suffer a hip fracture than those who didn't drink the white stuff.
That's not to say that calcium isn't important for bone health. The mineral is crucial for the building of healthy bones and teeth — especially during the teenage years when bones are growing at their fastest — and for proper heart, muscle and nerve function. But drinking 3 cups of low-fat or nonfat milk a day, as the government recommends, doesn't guarantee you'll get the calcium you need, the PCRM argues. The amount of calcium your body ultimately absorbs from food depends on a variety of other factors, including your genes, how much vitamin D you get, how much you exercise, and other dietary influences (animal protein, sodium and caffeine prevent calcium absorption, for example).
The PCRM's stance is that, milk being an imperfect vehicle for calcium delivery, people should seek to consume the essential nutrient from other sources with "a more healthful, nutritional profile," such as beans, tofu, broccoli, kale, collard greens, cereals and other calcium-fortified beverages like orange juice and soy milk.
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But then, when was the last time you saw a schoolchild with kale on his tray? Nutritionists argue that milk is still a primary source of calcium and one of the easiest ways for kids to get enough of the mineral daily. "I think it’s irresponsible to take this beverage that children enjoy, especially among those who are unable to meet their nutrient needs for the day, and remove it from the lunch line,” says Keri Gans, a registered dietician and author of The Small Change Diet.
And even if its benefits to bone health have been overblown, milk still packs plenty of other important nutrients: vitamin A, protein, potassium, riboflavin, niacin, vitamin B12 and phosphorus. Further, a 2008 study of more than 7,550 kids found that drinking plain or flavored milk was associated with higher overall nutrient intake, and was not associated with weight gain.
Dr. Keith Ayoob, associate clinical professor of pediatrics at the Albert Einstein College of Medicine in New York City, thinks milk should be part of every balanced diet. "Parents all over the country are trying to get kids to eat and drink foods that are good for them, and milk is one of them. It’s a drink that kids really like,” he says.
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The government's school lunch program requires that kids be offered fat-free or low-fat milk. The program's guidelines are based in part on the Agriculture Department's Dietary Guidelines for Americans, which recommend 2 to 2.5 cups of dairy a day for kids aged 2 to 8, and 3 cups a day for everyone over 9.
As far as bone health goes, however, it may be prudent for parents to focus less on kids' daily dairy consumption and more on their quota of exercise. Studies show that weight-bearing exercise like hiking, running or jumping rope is a key contributor to bone health in people of all ages, including kids and teens. But most people fall far short of the government's exercise recommendations — kids should be getting an hour or more a day — which helps explain why more than a third of American adults and 17% of kids and teens are obese. Losing weight also helps improve bone strength, as do refraining from smoking and drinking too much alcohol.
So, is it really necessary to ban milk from school lunches? This debate may have no winner. “Milk is a food like others. It is not poison; it is not a dietary essential. I can't think of any compelling reason not to include it in school lunches, but I also see no reason to require it,” says Marion Nestle, professor of nutrition, food studies, and public health at New York University. “Milk demonstrably has nutrients. Other foods have the same nutrients. It's just a food. Like other foods, too much might be a problem.”